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Children in the Kivu provinces of eastern Democratic Republic of Congo (DRC) are not only getting caught in the crossfire of the area's ongoing violence, but also facing health risks, threats of forced recruitment by local and foreign militias, and interrupted education, say officials.

"Children are swept up in the mass population movements that are currently ongoing in eastern DRC, with entire families fleeing multiple conflicts. Our hospitals have operated on children with bullet wounds who have been caught in the crossfire. Some children present late with life-threatening malaria, malnutrition or respiratory tract infections," Jan-Peter Stellema, operations manager at Médecins sans Frontières (MSF), told IRIN.

"Many [of the displaced] are hiding in the malarial forests of the interior for days or weeks at a time, cut off from medical care and difficult to reach. Others are living with Congolese host families, often strangers who share their food and living quarters with those on the run," Stellema said.

The insecurity has disrupted MSF's healthcare provision, with some of the organization's mobile clinics being suspended, added Stellema. "Some of our national staff feel unsafe and have also fled, leaving us functioning with skeleton teams in some project locations."

Children are also under threat of forced recruitment by insurgent groups in North Kivu, including M23 - a group of former DRC national army (FARDC) soldiers who mutinied in April - and both foreign and Congolese militias including the Mai Mai groups and the Forces Démocratiques pour la Libération du Rwanda (FDLR).

In a 19 September statement, a coalition of NGOs in the DRC said, "Children are not only directly exposed to the real risk of recruitment and re-recruitment; their vulnerability is also aggravated by the reduced activity of child protection organizations that are affected by the security situation."

The statement noted that the redeployment of the FARDC to contain M23 has "given free rein" to self-defence militias and armed groups that use children.

Renewed insecurity in South Kivu

Education in South Kivu Province has been disrupted by the destruction of dozens of classrooms, class sizes overwhelmed by displaced children and the fact that some schools have become temporary dormitories for IDPs, according to an OCHA report.

In the Hauts Plateaux area in Kalehe, in northern South Kivu, conflict between armed groups who are burning and pillaging houses is common, adds OCHA. In late August, at least 500 households fled the area of Kitopo following fighting between the FDLR and the Raïya Mutomboki militia.

"Civilians are facing an unprecedented, high level of armed violence due to the renewed activism of armed groups in the province," said Florent Mehaule, the acting head of the OCHA office in South Kivu Province.

In South Kivu alone, more than 374,000 people were displaced between January and August, creating growing needs for food assistance, non-food items, water and sanitation, said Mehaule.

Commenting on the situation in eastern DRC, MSF's Stellema said, "Despite the conflict, life goes on in the region and the regular health needs remain - there are still pregnant women who require antenatal care, or assistance with a complicated delivery, children who are susceptible to measles and need vaccinating... But many of the most vulnerable in the region are now unable to access the assistance they need."